Attachment A4 - Behavioral Health Consultation Provider SSI Notification Email - JBS_Final

Attachment A4 - Behavioral Health Consultation Provider SSI Notification Email - JBS_Final.docx

Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access and Screening and Treatment for Maternal Mental Health and Substance Use Disorders Programs Project

Attachment A4 - Behavioral Health Consultation Provider SSI Notification Email - JBS_Final

OMB: 0906-0105

Document [docx]
Download: docx | pdf

Behavioral Health Consultation Provider

Semi-Structured Interview

Notification Email

JBS Administered


Health Resources and Services Administration Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access and Screening and Treatment for Maternal Mental Health and Substance Use Disorders Programs Project



June 2024



Thank you for supporting the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) [Pediatric Mental Health Care Access (PMHCA)/Screening and Treatment for Maternal Mental Health and Substance Use Disorders (MMHSUD)] program, [insert program name]. HRSA funded JBS International, Inc. (JBS) to conduct an evaluation of the MCHB [PMHCA/MMHSUD] program (hereafter referred to as the HRSA MCHB evaluation). JBS is an independent evaluator of the program and is not part of HRSA or any other federal agency.


JBS is conducting a semi-structured interview (SSI) with a behavioral health consultation provider to learn more about the behavioral health consultation implementation of [insert location]’s HRSA [PMHCA/MMHSUD] program as part of research for the HRSA MCHB evaluation. The SSI is designed to collect information on your experiences with the [PMHCA/MMHSUD] program (e.g., program involvement, clinical behavioral health consultation processes, clinical behavioral health consultation requests, health equity, program usefulness).


This email is to notify you that JBS will be reaching out to you about the Behavioral Health Consultation Provider SSI within the next 2 weeks. Your participation in the SSI is completely voluntary, and you can withdraw at any time. If you choose to participate, the SSI will take about 45 minutes to complete and will be conducted and recorded (if permission is granted) via a web-based platform (e.g., Microsoft Teams, Zoom).


For questions about the study or if you have problems or concerns, contact [email protected].


For questions about your rights as a research participant, complaints, or problems, contact the JBS Institutional Review Board (IRB # AG19-001) at [email protected] or [email protected].

Kind regards,


The HRSA MCHB Evaluation Team


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCatherine Gulley
File Modified0000-00-00
File Created2024-10-27

© 2025 OMB.report | Privacy Policy